English
March 27, 2026
RESEARCH UPDATE March 27, 2026
Jonathon O. Russell, MD, FACS Director, Russell Center for Endocrine Health · Endocrine Surgeon
If you have had a kidney stone, you've almost certainly been told to drink more water. It's advice that makes physiologic sense — more fluid dilutes the urine, lowering the concentration of stone-forming minerals. Guidelines from major urology organizations recommend producing at least 2.5 liters of urine daily. The problem, as a landmark new study confirms, is that for many patients, better hydration alone simply isn't enough.
Published in The Lancet on March 19, 2026, the PUSH trial (Prevention of Urinary Stones with Hydration) was the largest behavioral study ever conducted for kidney stone prevention. Researchers enrolled 1,658 adolescents and adults at six major U.S. medical centers — including the Cleveland Clinic, Mayo Clinic, and the University of Washington — and followed them for two years.
One group received standard hydration advice. The other received a sophisticated behavioral program: personalized fluid prescriptions, Bluetooth-enabled smart water bottles tracking intake in real time, financial incentives, reminder texts, and one-on-one health coaching. Participants in the program did drink more — and their urine output increased — but the rate of symptomatic stone recurrence was virtually identical between the two groups.
1,658 Participants across 6 U.S. medical centers
2 yrs Follow-up measuring actual stone recurrence
~19% Recurrence rate in both groups — no significant difference
The study's authors were careful to note that hydration is still a valid prevention strategy — fluid intake is not the problem. The problem is that many patients cannot sustain the required volume day after day, and for some patients, the real driver of stone formation isn't dehydration at all.
"Achieving and maintaining very high fluid intake is more challenging than we often assume — and for some patients, hydration alone may never be enough to address the underlying cause."
Here is where this study carries a message that goes beyond urology: a substantial portion of patients with recurrent calcium kidney stones have an underlying parathyroid problem that no amount of water will fix.
The parathyroid glands — four tiny glands, each about the size of a grain of rice, located behind the thyroid in the neck — regulate calcium in the body. When one of these glands develops a benign tumor called an adenoma, it produces excess parathyroid hormone (PTH). Elevated PTH raises blood calcium levels, and the kidneys respond by excreting that excess calcium into the urine. The result is a condition called hypercalciuria — high urinary calcium — which is among the most common identifiable causes of recurrent calcium oxalate kidney stones.
This condition, known as primary hyperparathyroidism, affects approximately 1 in 400 adults. It often causes no obvious symptoms for years. Recurrent kidney stones are sometimes the only clue that something is wrong with the parathyroid glands.
The frustrating experience of many kidney stone patients — watching their stones return despite doing everything right — can often be traced to an untreated parathyroid adenoma quietly driving excess calcium into the urine, year after year. Drinking more water can help lower the concentration of that calcium, but it doesn't stop the source.
The definitive treatment for primary hyperparathyroidism is surgical removal of the overactive gland — a parathyroidectomy. When performed by an experienced surgeon, it is one of the most successful operations in all of medicine. More than 95% of patients are cured with a single procedure. For patients whose stones are driven by parathyroid disease, surgery often stops the cycle of recurrence entirely.
At the Russell Center, parathyroidectomy is performed as a minimally invasive, same-day procedure — patients go home the same day, without an overnight hospital stay, and without the need for general rehabilitation. For patients who prefer no visible scar on the neck, we also offer a scarless approach using a small incision hidden beneath the chin, the same corridor used in our TOETVA thyroid surgery program.
The PUSH trial is an important reminder that effective medical care requires finding the right answer, not just applying the standard answer. Hydration is good medicine. But if you have had more than one kidney stone — especially calcium stones — it is reasonable to ask your doctor to check your blood calcium and PTH levels. A brief blood test can determine whether a parathyroid problem may be silently at work.
If it is, there is a straightforward, durable solution. That's exactly the kind of problem we treat every day at the Russell Center.
A consultation at the Russell Center includes a thorough review of your labs, imaging, and history — and a clear answer about whether parathyroid disease may be contributing to your stones.
Source: Desai AC, Maalouf NM, Harper JD, et al. Prevention of urinary stones with hydration: a randomised clinical trial of an adherence intervention. The Lancet. 2026;407(10534):1171–1181. DOI: 10.1016/S0140-6736(25)02637-6
This article is written for patient education purposes. It does not constitute medical advice. Please consult a qualified physician regarding your specific medical history and circumstances.
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